CLER Pathways to Excellence: Expectations for an Optimal Clinical Learning Environment (Executive Summary)

The Accreditation Council for Graduate Medical Education (ACGME) recognizes the public's need for a physician workforce capable of meeting the challenges of a rapidly evolving health care environment. The ACGME has responded to this need by implementing the Clinical Learning Environment Review (CLER) program as a part of its Next Accreditation System. The CLER program is designed to provide US teaching hospitals, medical centers, health systems, and other clinical settings affiliated with ACGME-accredited institutions with periodic feedback that addresses the following 6 areas: patient safety, health care quality, transitions in care, supervision, duty hours and fatigue management and mitigation, and professionalism. The feedback provided by the CLER program is designed to improve how these clinical sites engage physician trainees in learning to provide safe, high-quality patient care.To further the aim of the CLER program, the ACGME has developed the CLER Pathways to Excellence as a tool to promote discussions and actions that will optimize the clinical learning environment. The CLER pathways are designed as expectations rather than requirements. It is anticipated that by setting these expectations, clinical sites that provide training will strive to meet or exceed them in their efforts to provide the best care to patients and train the highest-quality physician workforce.PS Pathway 1: Reporting of adverse events, close calls (near misses)PS Pathway 2: Education on patient safetyPS Pathway 3: Culture of safetyPS Pathway 4: Resident/fellow experience in patient safety investigations and follow-upPS Pathway 5: Clinical site monitoring of resident/fellow engagement in patient safetyPS Pathway 6: Clinical site monitoring of faculty member engagement in patient safetyPS Pathway 7: Resident/fellow education and experience in disclosure of eventsHQ Pathway 1: Education on quality improvementHQ Pathway 2: Resident/fellow engagement in quality improvement activitiesHQ Pathway 3: Residents/fellows receive data on quality metricsHQ Pathway 4: Resident/fellow engagement in planning for quality improvementHQ Pathway 5: Resident/fellow and faculty member education on reducing health care disparitiesHQ Pathway 6: Resident/fellow engagement in clinical site initiatives to address health care disparitiesCT Pathway 1: Education on care transitionsCT Pathway 2: Resident/fellow engagement in change of duty handoffsCT Pathway 3: Resident/fellow and faculty member engagement in patient transfers between services and locationsCT Pathway 4: Faculty member engagement in assessing resident-related patient transitions of careCT Pathway 5: Resident/fellow and faculty member engagement in communication between primary and consulting teamsCT Pathway 6: Clinical site monitoring of care transitionsS Pathway 1: Education on supervisionS Pathway 2: Resident/fellow perception of the adequacy of supervisionS Pathway 3: Faculty member perception of the adequacy of resident/fellow supervisionS Pathway 4: Roles of clinical staff other than physicians in resident/fellowS Pathway 5: Patients and families and graduate medical education supervisionS Pathway 6: Clinical site monitoring of resident/fellow supervision and workloadDF Pathway 1: Culture of honesty in reporting of duty hoursDF Pathway 2: Resident/fellow and faculty member education on fatigue and burnoutDF Pathway 3: Resident/fellow engagement in fatigue management and mitigationDF Pathway 4: Faculty member engagement in fatigue management and mitigationDF Pathway 5: Clinical site monitoring of fatigue and burnoutPR Pathway 1: Resident/fellow and faculty member education on professionalismPR Pathway 2: Resident/fellow attitudes, beliefs, and skills related to professionalismPR Pathway 3: Faculty engagement in training on professionalismPR Pathway 4: Clinical site monitoring of professionalism